Preventing the preventable cancer
Zero Cervical Cancer in
RAK / UAE by 2020
Fact is ……. While it is possible for a
Global Burden of Cervical Cancer
Courtesy Dr Jalaa Taher, HAAD
Cytology based screening for Cervical Cancer
Limitations of cytology
Reproducibility of Cervical cytology after reviewing 5000 slides
Cytology Screen categoriesBethesda Scoring
Management of women with LSIL
Draw backs of cytology screening(Roche submission to US FDA March 2014)
Harald zur Hausen 1984 isolated HPV 16 from Cx tissue
Awarded Nobel Prize 2008
Relative sensitivities of cytology & HPV testing
Co Testing
Genotypes separately & simultaneously reported by Star Metropolis Clinical Lab
Primary HR HPV Screening with reflux cytology
Courtesy Dr Jalaa Taher, HAAD
Courtesy Dr Jalaa Taher, HAAD
Courtesy Dr Jalaa Taher, HAAD
UAE study Age distribution
n = 314
2
33
84
63
48 46
21 18
0
10
20
30
40
50
60
70
80
90
< 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 > 51
number
number
HPV Genotypes in UAEn = 126
8 LR genotypes 14 HR genotypes
Genotype distribution in different age groups (n = 126)
Age group Genotypes
< 20 [39, 59]
21 - 25 [6, 6, 11,51] [16, 51,61,66] [53] [11,18,31,39,58][42]53, 66, 66, [66,59,52], [52,73], 31, [66,35,54,6]
26 - 30 [16] [42,43,51,66] [6] [16,39.52,61,68] [6,39,61,68,73][56,42,43], 33, [35,53], [52,70], 42, 16, 6, [51,39,42,6]
31 - 35 [52] [43,58,59,66] [11,16,42,43,53,61,61] [16,73,82] [6,52]66, 51, [58,16], [33,6], 44
36 - 40 [16,70] [6] 54, [59,31,42,11], [18,54], 18
41 - 45 [42,51,68] [42,53,59] [42,59] [16,16,18,52] [53,53,68,70]53,58,51
46 - 50 [16] [6, 42], 33
> 51 [16], 53, [33,82], 33, 53, [51,33,35,42,6]
HPV genotypes in UAE
02468
10121416
geno
type
6 L
g 11
Lg
16 H
g 18
Hg
31 H
g 33
Hg
35 H
g 39
H
g 42
Lg
43 L
g 44
L
g 51
Hg
52 H
g 53
H
g 54
Lg
56 H
g 58
H
g 59
Hg
61 L
g
66 H
g 68
Hg
70 L
g
73 H
g 82
H
14 HR genotypes : 808 LR : 46
HPV Genome
• E1-E7 = “Early” genes (nonstructural)
• L1, L2 = Capsid genes• URR = upstream regulatory
region
• E6 & E7 proteins play major role in immortality & malignant transformation of infected cells
• E5 has role, but not required to maintain cancer phenotype
Munoz et al. 2006.
Why Cervical Cancer is preventable ?Natural History of HPV infection
HPV-containing double stranded DNA
‘Empty’ non-infectious virus-like particle (VLP)
mimics the virus
Virus-like particles (VLPs) as HPV vaccine antigens mimic the virus structure
Stanley M, et al. Vaccine 2006; 24(suppl 3):S3/106–113.
Vaccines
• Gardasil (2006) : – Contains HPV 16, 18, 6, 11
• Cerverix (2009): Contains HPV 16, 18– Females 10 through 25– For:
• Ca Cx• CIN• Adenocarcinoma in situ
– Gardasil for males too and for Ca Anus, warts etc
Two Opportunities to prevent Cx Ca
Normal cervix
HPV infection
Cervical Intraepitheilial neoplasia
CIN
Cervical Cancer
HPV vaccine
HPV & Cx screen & t/t
10- 18 18 – 25 > 30
Collection of Cx Swab
Cervical Cancer is entirely preventable
1.Vaccination before exposure2.Screening after 30 yrs (every 5 yrs)
Though STI, it does not imply un-faithfullness
Cancer free RAK / UAE by 2020 Become a national achievable goal
Insurance be instructed to approveVaccination & Co-testing
Please Join, Support & Promote
Scientists have the tools, but cannot do it alone
Thank you for your attention